Quality Assurance Nurse(Osun) at Stresert Services Limited

Job Responsibilities

• Attend to and resolve all enrollees’ enquires and ensure that all complaints are promptly resolved on first call resolution, or immediately escalated to the appropriate group or unit.



• Meticulously log all for management analysis and documentation for all relevant stakeholders.



• Follow-up on specific cases as assigned by the line manager for measurable outcomes and stakeholders’ satisfaction.



• Actively and proactively engage in the vetting of bills from the organization’s network of facilities providing secondary/tertiary healthcare services on the public sector social health insurance program



• Benchmark all received claims with the pre-authorized codes given by call center as any service provided by any facility without pre-authorized code is considered null and void.



• Review all the received bills and possibly contact the enrollees for authorization of services provided.



• Investigate and report any incident of abuse, neglect or maltreatment of enrollees immediately to the Management for appropriate actions to be taken.



• Follow up on enrollees on admission to evaluate and document their progress and possibly assist the care team with developing and accessing health interventions.



• Participate in case management through scheduled and unscheduled visitation to enrollees on admission.

Education

• Graduate Professional Nurse and First Degree from an accredited Baccalaureate Nursing Program (University)



• Must be a registered and licensed practitioner.



• Possession of recognized additional training in primary health care and midwifery is desirable.

Experience

• Applicants must have at least 2 years experience as a Nurse and Midwifery Professional.



• Ability to work seamlessly with Computer and other communication equipment and software.